Chapter 9 - Clinical Corner

A nosocomial infection has broken out in the hospital. The organism responsible is a Gram-positive spore forming bacillus. You are asked to devise a strategy to deal with this problem.
A. What is the most important consideration?
B. Should you recommend changes in hospital disinfection procedures?
C. Should you consider any recommendations about patient therapy protocols?

This question involves two parts, the first is the nosocomial nature of the infection and the second is the ability of the infectious pathogen to form an endospore.
Question A: Nosocomial infection can be wide spread throughout the hospital. Therefore it is important to look at all areas of the hospital.
Question B: In order to make recommendations, look for ways to deal with the infection. Consider the protocols that are in use for disinfection and antisepsis and look for methods that will enhance the chance of destroying these organisms effectively. Those that you find should be made part of the standard operating procedures used in the hospital.
Question C: Because there is a potential for this organism to survive the methods used to disinfect the clinical environment, vigilance in search of infections is required. This vigilance will help with making recommendations about the potential for future outbreaks of these infections.

Your patient is suffering from an intestinal infection. After several days on broad-spectrum antibiotics without improvement, the patient was admitted to the hospital. A routine lab workup reveals that the pathogen responsible for the infection is a Gram-negative bacillus.
A. What other characteristics of the organism would be useful for you to know about? B. What other information could be useful for developing a plan for the treatment of the patient?

Question A: It is important to know whether the organism in question is resistant to antibiotics. It seems likely this is the case since broad-spectrum antibiotic therapy has not been effective. Therefore it would be useful to perform multi-antibiotic resistance tests to learn whether resistance is present and how widespread in the hospital population the resistance is.
Question B: Multi-antibiotic resistance tests can also confirm whether there are other antibiotics that might be useful for treatment. A second important piece of information that would be helpful is the current status of the patient’s immune response as this will play a pivotal role in defining a new approach for treatment.